Neurosurgery Module- Spine Flashcards
what parts of the spinal cord contain a lateral horn?
thoracic and upper lumbar spine
what does the lateral horn contain?
sympathetics
dermatome for medial malleolus?
L4
dermatome for toes 4 + 5 + lateral malleolus?
S1
dermatome for dorsum of the foot and toes 1-3
L5
what vertebrae have short and bifid spinous processes
C3-C5
most common locations for lumbar disc herniation?
L4/5
L5/S1
most common direction of a disc prolapse? what nerve will be affected from this?
posterolateral
will affect the lower nerve
what is a radicuopathy?
dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the affected nerve’s muscle groups
describe sciatic pain?
shooting pain from bum down to posterior leg/knee
exaggerated by valsalva
presentation of a prolapsed L5/S1 disc with S1 damage?
pain along posterior thigh with radiation to heel
weakness of plantar flexions
sensory loss in lateral foot
reduced/absent ankle jerk
pain in anterior thigh and wasting of the quad muscles and a reduced knee jerk is likely to indicate what nerve root’s pathology?
L4
what would make you do a discectomy?
failure of physio and drugs pain central disc prolapse tumour neuro deficit
bilateral sciatica indicates a central disc prolapse T or F
T
a disc prolapse where can cause cauda equina syndrome?
L4/5 midline herniation
causes of cauda equina?
prolapsed lumbar disc tumour compression trauma infection haematoma
Ix for cauda equina?
MRI lumbosacral spine
PR exam
Tx for cauda equina syndrome from disc herniation/
discectomy
Tx for cauda equina syndrome from fracture?
decompression + fixation
symptomatic lumbar spinal stenosis most commonly occurs at what levels?
L4/5
L3/4 is next most common
causes of spinal stenosis
hypertrophy of facet joints and ligamentum flavum
protruding intervertebral discs
spondylolisthesis
presentation of spinal stenosis?
unilateral burning hip/buttocks/leg pain insidious onset relieved by sitting/lumbar flexion better walking downhill neurogenic intermittent claudication
Ix of neurogenic claudication?
MRI lumbosacral spine
surgical Tx of lumbar spinal stenosis
lumbar laminectomy
pathological process in cervical spondylosis?
degenerative arthritis involving cervical spine and IV discs
does a radiculopathy cause UMN or LMN signs
LMN
clinical features of a cervical spondylosis?
radiculopathy
myelopathy
classic radiographic appearance of cervical spondylosis?
narrowing of disc space
osteophytes
Tx of cervical spondylosis?
laminectomy if due to osteophytes
discetomy if disc prolapse
does myelopathy cause UMN or LMN signs?
UMN
symptoms are more prominent where in degenerative cervical myelopathy
lower limbs hence FALLS
presentation of degenerative cervical myelopathy?
imbalance of gait -> falls
clumsy hands
non-dermatomal pain
weakness
examination findings of cervical myelopathy?
weakness hyperreflexia spasticity \+ve babinski and hoffman's signs loss of dexterity
Ix for cervical myelopathy?
MRI c spine
cause of anterior cord syndrome?
infarction of the area supplied by the anterior spinal artery
presentation of anterior cord syndrome?
BELOW the level of injury:
paralysis
loss of pain
temperature
what cord functions are unaffected in anterior cord syndrome?
proprioception
vibration sensation
presentation of a complete cord transection?
spinal shock THEN UMN symptoms
ipsilateral UMN paralysis and contralateral loss of pain and temp sensation below the level of the lesion indicates what condition..
brown sequard syndrome
bilateral upper limb weakness with some lower limb weakness is indicated by what condition and why?
central cord syndrome
the fibres for the arms are more medial to that for the legs so a central cord lesion will affect them more
